Short-term prophylactic antibiotic for elective abdominal hysterectomy: how short?

A prospective double-blind study was conducted in order to evaluate the effect of antibiotic prophylaxis on patients undergoing elective abdominal hysterectomy. In the first stage of the study, 116 patients received, on call to the operating room and subsequently 8 and 16 h post-operatively, cefazolin sodium or placebo. In the second stage of the study, 90 patients received the same antibiotics, but treatment was extended to 6 doses, 8 h apart. Of the 53 women who received placebo, 27 (50.9%) became morbid, while only 15 of the 63 (23.8%) who received 24 h prophylaxis were classified as morbid (p < 0.005). By extending the prophylactic treatment to 48 h further reduction of the morbidity was achieved. Of the 90 patients only 11 (12.2%) became morbid (P < 0.005). When morbidity rates were compared between different ethnic groups, over-weight and normal weight patients, pre- and post-menopausal women, it was not possible to define a group which is at a higher risk for post-operative morbidity. It was thus concluded that prophylactic antibiotics should be administered routinely to all patients undergoing abdominal hysterectomy, preferably for 48 h.